Jefferson Investigates: October 2026

Patients with early-stage lung cancer undergo surgery unless preoperative evaluation reveals poor lung function, which is predictive of poor outcomes. Imaging – like MRI or CT scan – isn’t the standard of care for conventional evaluation, due to issues like cost, the need for contrast, and inaccuracy.

Thomas Jefferson University researchers used another imaging modality – four-dimensional computed tomography (4DCT)-ventilation – to preoperatively assess lung function in patients with early-stage lung cancer. 4DCT-ventilation is often used in radiation oncology, but this is the first time it was used in a surgical trial. Their findings were published in the International Journal of Radiation Oncology - Biology - Physics.

“The conventional method of predicting lung function before surgery assumes that lung function is evenly distributed,” says Lydia Wilson, PhD, the study’s first author. “For patients with conditions affecting lung function, the portion you remove during surgery might not be functioning well, or it might be the only portion that’s working very well, which would be detrimental to remove.”

This pilot study evaluated data from 30 surgery eligible patients with early-stage lung cancer. 4DCT-ventilation images didn’t influence clinical decision-making, because data analysis occurred after the trial.

While undergoing 4DCT, patients are instructed to inhale and exhale, to capture real-time lung activity. 4DCT images create a video of the lungs moving during breathing. The researchers use image-processing techniques to convert this movie into a map showing which parts of the lung function well and which don’t. These maps could help determine surgical eligibility. 

Months after surgery, researchers compared predictions from the conventional technique and 4DCT-ventilation imaging. Both approaches had similar accuracy, but 4DCT-ventilation predictions were more accurate in patients with uneven lung function, which can affect patients with COPD or emphysema.

Using 4DCT-ventilation preoperatively may eventually guide clinical decision-making, but more research is needed.

“The hope is that 4DCT-ventilation is better than existing techniques and could remove the need for imaging modalities that are less patient-friendly, take longer, cost more, or require contrast,” Dr. Wilson says.

Dr. Wilson, a member of Sidney Kimmel Medical College, plans to study 4DCT-ventilation imaging on patients with borderline or low lung function, to assess their eligibility for surgery.

Jefferson medical physics resident Vikas Aragam, PhD, contributed to the research. Interdisciplinary collaborators include Dr. Tyler Grenda, Dr. Julie Barta, and Dr. Benjamin Leiby.

By Lisa Fields

New findings by researchers at Thomas Jefferson University show how an inexpensive, off-patent compound can improve functioning in people with multiple sclerosis, a chronic neurodegenerative disease that affects vision, muscle coordination, and cognitive function.

Current treatments for the autoimmune disorder are appropriately designed to dampen patients’ overreactive immune systems. The new study, published in IBRO Neuroscience Reports, added a compound called N-acetylcysteine to ongoing treatment and demonstrated better outcomes in a majority of patients.

N-acetylcysteine (NAC), targets oxidative stress, thus targeting the biological pathway that contributes to nerve damage in multiple sclerosis. In addition, NAC is a widely available drug that has minimal side effects. (It’s available as an oral supplement, though in medical settings, it’s given intravenously and considered a drug.)

“Every hospital has it,” says Daniel Monti, MD,  professor and chair of the Department of Integrative Medicine and Nutritional Sciences. “It’s used in Tylenol overdose cases, in which oxidative stress is one of the contributors to liver failure.”

The drug works by raising levels of glutathione, a naturally occurring antioxidant. People with multiple sclerosis often have lower levels of these protective compounds. “You could say we’re replenishing rather than supplementing,” Dr. Monti says.

In pilot studies with N-acetylcysteine, multiple sclerosis patients reported positive effects such as better cognition, less fatigue, and lower anxiety. The current study measured changes in brain function with positron emission topography (PET imaging).

Using PET imaging, the team saw improved functional connectivity in the brain. “It’s a measure of how different parts of the brain are working together,” says Andrew Newberg, MD, director of Jefferson’s PET/MRI imaging program and an integrative medicine faculty member alongside Dr. Monti. “Multiple sclerosis is breaking connections and NAC helps reestablish them. In short, it helps the brain work better.”

It turns out that NAC has also shown promise in other neurological diseases such as Parkinson’s. It crosses into the brain to increase glutathione levels. Dr. Monti emphasized, “There’s so little downside, because it’s such a safe compound.”

The researchers say larger scale studies are needed to confirm their findings and to determine optimal dosing regimens. Dr. Monti is encouraged to continue this line of research, such as testing the compound in people with traumatic brain injury. “So far, NAC has been a winner,” he says.

By Jill Adams